Advances in HIV Prevention for Serodiscordant Couples

Muessig, Kathryn E.; Cohen, Myron S.

doi:10.1007/s11904-014-0225-9

Cited by 53 publications

(51 citation statements)

References 101 publications

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“…1,9 It seems likely that high adherence can be expected in many groups of couples given the fact that ART dramatically suppressed HIV transmission in 10/12 observational studies. 32 Adherence to treatment is likely optimized when evidence based counseling is an ongoing part of provision of ART, 33,34 when couples are counseled together, when the prevention benefit to the sexual partner is made clear, and when feedback about viral suppression is provided. These data suggest the potential utility of implementing these approaches in clinical settings.…”

Section: Discussionmentioning

confidence: 99%

Adherence to Early Antiretroviral Therapy

Safren

Mayer

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Combination antiretroviral therapy (ART) for HIV-1 infected individuals prevents sexual transmission if viral load is suppressed. Methods Participants were HIV-1 infected partners randomized to early ART (CD4 350-550) in HPTN052 (n=886, median follow-up = 2.1 years), a clinical trial of early ART to prevent sexual transmission of HIV-1 in serodiscordant couples at 13 sites in 9 countries. Adherence was assessed via pill-count (dichotomized at <95%) and via self-report items. Predictors of adherence were mental health and general health perceptions, substance use, binge drinking, social support, sexual behaviors, and demographics. Viral suppression was defined as HIV plasma viral load <400 copies/ml. Adherence counseling and couples counseling about safer sex was provided. Logistic and linear regression models using generalized estimating equation for repeated measurements were employed. Findings Via pill-count, 82% of participants were adherent at 1 month and 83.3% at 1 year. Mental health was the only psychosocial variable associated with adherence (pill-count OR=1.05: 95% CI: 1.00 – 1.11; self-report parameter estimate (b)=0.02, 95% CI: 0.01 –0.04), though regional differences emerged. Pill-count (OR=1.19, 95% CI: 1.10-1.30) and self-report (OR=1.42, 95% CI: 1.14-1.77) adherence were associated with viral suppression. Interpretation While adherence was high among individuals in stable relationships taking ART for prevention, mental health and adherence co-varied. Assessing and intervening on mental health in the context of promoting adherence to ART as prevention should be explored. Adherence and couples counseling, feedback about viral suppression, and/or altruism may also help explain the magnitude of adherence observed.

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Section: Discussionmentioning

confidence: 99%

Adherence to Early Antiretroviral Therapy

Safren

Mayer

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…First, antiviral agents have been used as treatment, as effective treatment of an infected person reduces transmission probability in both heterosexual couples 49,111 and MSM couples 112 to a negligible level. Second, antiviral agents have been used as PrEP for men and women at high risk of HIV-1 infection.…”

Section: Bottlenecks Inform Prevention Strategiesmentioning

confidence: 99%

Bottlenecks in HIV-1 transmission: insights from the study of founder viruses

et al. 2015

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HIV-1 infection typically results from the transmission of a single viral variant, the transmitted/founder (T/F) virus. Studies of these HIV-1 variants provide critical information about the transmission bottlenecks and the selective pressures acting on the virus in the transmission fluid and in the recipient tissues. These studies reveal that T/F virus phenotypes are shaped by stochastic and selective forces that restrict transmission and may be targets for prevention strategies. In this Review, we highlight how studies of T/F viruses contribute to a better understanding of the biology of HIV-1 transmission and discuss how these findings affect HIV-1 prevention strategies.

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“…It refers to the provision of ART before possible exposure to an HIV-positive partner in unprotected sex. 10 Studies 10,11 show even higher reduction in HIV transmission risk when more than one preventive strategy is concomitantly used. Thus, the consistent and regular use of condoms is still a practice of great importance, complementary to the latest preventive measures and which is part of the PLWHA on a daily basis, notably regarding serodiscordant couples, i.e., heterossexual or homossexual couples where only one of the partners is HIV-positive.…”

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confidence: 99%

Sorodiscordância e prevenção do HIV: percepções de pessoas em relacionamentos estáveis e não estáveis

Said

Seidl

2015

Interface (Botucatu)

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Policies regarding post-sexual exposure prophylaxis (PEP) and the "treatment as prevention" strategy have strengthened preventive measures against HIV transmission. This study aimed to describe the perceptions of people with HIV/AIDS regarding prevention of sexual transmission of HIV in the context of serodiscordance. Two focus groups were conducted, with 13 HIV-positive participants who were in serodiscordant relationships: one group with people in stable partnerships and the other in non-stable relationships. Just over a third of participants were aware of PEP and "treatment as prevention". There was a consensus that it is easier to use safe-sex practices in non-stable serodiscordant relationships, it is easier to use safe-sex practices. Some advantages of the new policies were mentioned, despite the concern that condom use might be neglected. The importance of healthcare teams' actions among serodiscordant couples regarding prevention of sexual transmission of HIV was highlighted. A great number of advances can be perceived since Acquired Immunodeficiency Syndrome (AIDS) was first identified in the early 1980s. Nevertheless, AIDS still remains at epidemic rates, representing a public health problem in Brazil. 1 With the advent of antirretroviral therapy (ART) -which acts on the multiplication of HIV causing a reduction in the viral load and, consequently, an increase in CD4 T-cells and recovering of the immune system -AIDS is currently considered a chronic disease that, even with no cure, enables that people living with HIV/AIDS (PLWHA) have a satisfactory quality of life. [2][3][4][5] By promoting the distribution of antirretroviral therapy from 1996, the Brazilian Public Health System enabled access to treatment as a possibility of PLWHA achieving a good quality of life. As a consequence, other issues have taken place, such as the constitution of serodiscordant couples -a term used to refer to heterossexual or homossexual couples where only one of the partners is HIV-positive. 6,7 Preventive measures against sexually transmitted HIV undergone significant changes over the course of the HIV epidemic. The regular and consistent use of male condoms, followed by the female condoms, was the first preventive measure for fighting against HIV, with good efficacy levels at relatively low costs, being adopted worldwide as a public health measure. Moreover, scientific evidence has recently consolidated additional actions which are being implemented: the so-called "treatment as prevention", referring to the HIV-positive person receiving ART regardless of his/her own immune status (CD4 T-cells count). That treatment enables the patient to obtain a minimum level of viral copies in the body, situation where the virus is undetectable, significantly reducing the chances of transmission.Evidences indicate a 96% sexual transmission reduction of HIV when the HIV-positive female or male partner has been on ART and has an undetectable viral load. 8,9 Another preventive measure backed up by scientific evidence and adopted by the B...

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Advances in HIV Prevention for Serodiscordant Couples

Cited by 53 publications

References 101 publications

Adherence to Early Antiretroviral Therapy

Adherence to Early Antiretroviral Therapy

Bottlenecks in HIV-1 transmission: insights from the study of founder viruses

Sorodiscordância e prevenção do HIV: percepções de pessoas em relacionamentos estáveis e não estáveis

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